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ROMAN MEDICINE  denounced Greek physicians as the worst enemies of Rome

and accused them of poisoning and murdering their clients


 enemy of all doctors
 advocated cabbage as a universal remedy
OUTLINE
-used on wounds
I. MEDICINE IN THE ROMAN WORLD
A. The Romans  provided a charm that was supposed to reduce dislocation
B. Cato the Elder  lived at the ripe old age of 84 when the average life
C. Asclepiades expectancy during the era was about 25 years
D. Pliny the Elder
E. Descorides  PUBLIC HEALTH AND ENGINEERING
F. Aulus Cornelius Celius  Sanitary Engineering Achievements
G. Aretaus - played an important role in maintaining public health
H. Soranus - associated with Republican and Imperial Rome
II. GALEN AND GALENISM  Hospitals – only for the military
A. Galen
 Public Baths
III. GALEN ON ANATOMICAL PROCEDURES
IV. GALEN ON PHYSIOLOGY: BLOOD, BREATH, PNEUMA - half the water: for public bath
AND SPIRITS - other half: for two million residents
V. GALEN ON THERAPEUTICS AND CAUSES OF DISEASE  Healthy Practice of Cremation
I. MEDICINE IN THE ROMAN WORLD - The writings of other Romans reflect valuable insights
 The Roman Empire into problems of hygiene, sanitation and public health,
- was a complex and vigorous combination of Greek and especially the importance of water supplies and
Roman cultural elements, forged through centuries of sewage disposal.
war  On Architecture (ca. 27 B.C.E.)
A. The Romans - written by Vitruvius (Roman Architect and Engineer)
 Originally a republic of yeoman farmers, rather than - a text on an admirable concern for the purity of water and
merchants and adventurers like the Greeks sanitary location of dwelling places
 Excelled in the arts of warfare and administration,  Marcus Terentius Varro (117-27 B.C.E.)
architecture, engineering, public health and hygiene - suggested that swampy places might be inhabited by
 Healing of the sick as a family duty extremely minute animals that could enter the body
 Did not employ physicians through the mouth and nose and can cause serious illness
 Considered doctors as slaves  Romans were soon eagerly consulting Greek physicians who
 Skeptical of professional physicians
B. Asclepiades
 Relied on combination of magic and folklore to fight disease
offered them a medical regimen more sophisticated than
 Considered it was ethical o charge fees for treating sick
cabbages and incantation.
 Roman surgeons could perform amputations and plastic
surgery as well as operations for bladder stones, goiter,  came to Rome as a rhetorician
hernia, cataract and snakebites  offered treatments that were guaranteed to wok “swiftly,
 Comparing Rome to Greece safely, and sweetly”
 advised a sensible regimen with individualized attention to
 Critics characterized the Romans as people without art,
diet, rest and exercise, along with simple remedies such as
literature, science or philosophy.
 However, they could never be called to a people without C. Pliny the Elder
Gods since they accumulated deities for all major organs wine, water and cold baths
and functions of the body.
 Nevertheless, they still had room in their hearts for new
 “It is quite certain that a person never has his eyes gouged
deities, especially when the old ones seemed unwilling to
without feeling sickness at the stomach.”
do their jobs.
 suspicious of professional physicians
 complained that physicians learned their craft by
 293 B.C.E. – traditional Gods were unable to stop a
experimenting on patients and denounced them as the only
pestilence that was decimating Rome, the elders then
men who could kill with impunity and blame death on the
consulted Asclepius at the Temple of Epidarius. While
victim for having failed to obey professional advice
the Asclepiads conferred with the Roman delegation, a  Pliny’s Natural History
sacred snake emerged from the temple and boarded the  suggested simple prescriptions such as:
ship; this was taken as an omen that the Greek god of  Wound Dressings – made of wine, vinegar, eggs, honey,
medicine intended to help Rome. A temple for Asclepius was powdered earthworms and pig dung
constructed at a site selected by the snake, the epidemic  Treatment of Parasitic Worms – ferns
ended, and the cult of Asclepius was established in Rome.  Ephedron – for asthma, cough and hemorrhage
However, the reception the Greeks received was not always

D. Dioscorides
quite as warm as that awarded to Asclepius.

A. Cato the Elder

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 exemplifies the generalization that Roman Medicine was o We know them today as cardinal signs of
usually carried out by Greek physicians inflammation
 serve as a medicus to Nero’s armies  De re medicina (On Medicine)
 studied many novel plant species, hundreds of which were  the first medical work in Latin
not known to Hippocrates  provides a valuable survey of the medical and surgical
 provided valuable information about medically useful plants, practices of first-century Rome
their place of origin and habitat, growth characteristics and  After the death of Hippocrates, Greek medicine, which was
proper uses never a monolithic enterprise fragmented into various
disputation sects, some named after individuals and others
such as the Dogmatists, Empiricists and Methodists for their
special approach to medical theory.
 The Dogmatists
- emphasized the study of anatomy and claimed
Erasistratus, Herophilus and Hippocrates as their
ancestors
- taught that physicians must study anatomy and
physiology as well as the evident, immediate and
obscure causes of disease
Figure 1: Dioscorides examining medicinal plants  The Empiricists
 De materia medica (The Materials of Medicine) - believed it was necessary to understand evident or
 compiled by Dioscorides has many bizarre and immediate causes
unpleasant recipes - claimed that the study of anatomy was totally useless
 based the classification of drug affinity system rather for understanding living beings
than on traditional methods such as plant morphology or - regarded human vivisection with horror and held it a
habitat crime to cause death in the name of the healing art
 Many of the herbal remedies identified and classified by - emphasis on action was reflected in the excellent
Dioscorides can be found on the spice shelf of the average reputation of Empiric surgeons
modern kitchen:  The Methodists
 Cinnamons and cassia - believed that the body was composed of atoms and
- used as treatment of inflammations, venomous bites, pores
poisons, runny noses and menstrual disorders - disease was the result of abnormal states of the pores
 Asparagus due to excess tension or relaxation
- recommended as a means of inducing sterility and - thus, knowledge of the three common conditions of
wearing the stalk as an amulet was said to increase the the human body – the constricted, the lax and the
effectiveness of the prescriptions mixed – provided all the guidance the physician
 River Crabs, Gentian Root and Wine needed to treat his patients.
- remedy for victims of bites by mad dogs, then to prevent - claimed that no further research into the causes of
complications the patient should eat the liver of the dog disease and therapeutics were necessary because their
in question and wear its tooth as an amulet system was complete
 Bedbugs mixed with meat and beans - Juvenal, a Roman satirist, said that Methodist
- remedy for malaria practitioners had killed more patients than they could
count.

E. Aulus Cornelius Celsus


 Celsus concluded that no sect was wholly right or wrong. In
 wrote the first medical work in Latin
seeking impartially for the truth, it was necessary to
 not a doctor but a wealthy landowner
 declared that vivisection was cruel and unnecessary even recognize that some things that were not strictly pertinent to
though anatomy was an important part of medical medical practice were valuable in stimulating and improving
knowledge the mind of the practitioner.
 discussed surgery and described the signs of infection n  Properly considered, the art of medicine could be divided
surgical wounds into three parts:
 According to him, surgery should be the most satisfying field - Cure by diet (Lifestyle)
for the practitioner because it brought results that were - Cure by medications
more certain than practitioner treatment by drugs and diets - Cure by surgery
 described the signs of infection in surgical wounds  The art of medicine should be rational, Celsus concluded
 had mastered tools and techniques that were unknown to and based on immediate causes, but ultimately medicine
his Hippocratic predecessors such as the use of ligature for was an art that entailed a great deal of informed
torn blood vessels and special spoons and dilators to remove guesswork.
barbed arrows from wounds F. Aretaus
 Calor (heat), Rubor (redness), Dolor (pain), and Tumor
 Described diabetes as “a liquefaction of the flesh and bones
(swelling)
into the urine”
o Four signs of infection
o Polyuria
 Diabetes, in Greek, means, “I pass through”

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 Mellitus, meaning “sweet” or “honey”  he left Pergamum after the death of his father to continue
 Coined the terms “tetanus” and “opisthotonous” his medical education in Smyrna, Corinth and Alexandria
 he was appointed as physician to the gladiators on returning
G. Soranus
to Pergamum: observed and learned a lot from anatomy of
 Studied Gynecology and Conception gladiators
 Described the anatomy of the female organs  In, 161, he arrived in Rome where through good fortune,
o Described ovaries using the term didymus meaning “twin brilliant diagnoses and miraculous cures he soon attracted
gonads” many influential patients, patrons and admirers
 Described the use of pessaries for contraception  He engaged in public anatomical lectures, demonstrations
 Invented vaginal speculum and disputes composed some of his major anatomical and
physiological texts
 He returned five years later to Pergamum claiming that the
II. GALEN AND GALENISM hostility from other physicians drove him out of Rome
however his critics noted that his abrupt departure coincided
A. Galen with the outbreak of an epidemic that had entered the city
along with soldiers returning from Parthian war
 Physician known as the Medical Pope of the Middle Ages  He permanently stayed in Rome and serve as a physician as
and the Mentor of Renaissance anatomists and a request from Emperor Marcus Aurelius and enjoyed the
physiologists camaraderie and protection offered by the said emperor,
 Left voluminous writings that touch on all the major medical, Commodius Septimus, Severus and other prominent figures
scientific, philosophical and religious issues of his time
 Emperor Marcus Aurelius called him the “First of  On His Own Books
Physicians and Philosophers” - a guide for cautious readers composed by Galen to
 Scholars have said that as a physician, he was essentially a described his genuine works as well as a reading program
Hippocratic but as a philosopher, he was generally an for physicians
Aristotelian - unfortunately, a fire in the Temple of Peace in 191,
 Most prolific writer on medical subjects of ancient times destroyed many of his manuscripts
- wrote books on circulations and vessels  Galen taught that the best physician was also a
 Advocated energy blood letting philosopher. Therefore, a true physician must master the
- Women who bleed monthly has fewer disease compared three branches of philosophy:
to men who do not bleed  Logic, the science of how to think
 Believed that nerves were hollow ducts and carried pneuma  Physics, the science of nature
or vital spirits to the muscles  Ethics, the science of what to do
 Born in Pergamum, a city in Asia Minor that claimed to be  With such knowledge, the physician could gain his patient’s
the cultural equal of Alexandria. obedience and the admiration due to a god. Ideally, the
 14 years old, he had mastered mathematics and philosophy physician would practice medicine for the love of mankind,
 Asserted he had emulated the excellent character of his not for profit because the pursuit of science and money were
father mutually exclusive.
 Anatomical research for Galen was the source of a “perfect
theology” when approached as the study of form and
function in terms of the usefulness of the parts. Instead of
sacrificing for bulls and incense, the anatomist demonstrated
reverence for the Creator by discovering his wisdom, power
and goodness through anatomical investigations.

III. GALEN ON ANATOMICAL PROCEDURES


 Dissection was a religious experience for Galen.
 Systematic dissection
- essential preparation for the surgeon, because a
Figure 2: Galen contemplating on Human Skeleton practitioner without anatomical knowledge could
 Aelius Nikon inadvertently or negligently injure his patients.
- a wealthy architect, known for his amiable and benevolent - where the surgeon could choose the site of incision,
nature is the father of Galen. knowledge of anatomy would allow him to do the least
- he was told by Asclepius that his son would become a damage possible.
physician - On the other hand, if the surgeon had to sever muscles
to treat an abscess, his anatomical knowledge would
allow him to predict subsequent damage and thus
 composed three books while still a student of medicine at
escape blame.
the famous sanctuary of Asclepius in Pergammum
- Anatomy could also be used to settle larger philosophical
 he emphasized the importance of fostering a love of truth in issues, such as the controversy about the seat of reason
the youth that would inspire them to work day and night to in the human body.
learn all that had been written by the Ancients and to find
ways of testing and proving of such knowledge

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 Aristotelians  The heart and arteries were responsible for the
 placed reason in the heart, while others placed it in the maintenance and distribution of innate heat and pneuma
head. or vital spirits to warm and vivify the parts of the body.
 One Aristotelian argument was that the voice, which is
the instrument of reason, came from the chest.  The third adaptation, which occurred in the brain,
 Galen’s demonstration that the recurrent laryngeal produced the animal spirits required for sensation and
nerves control the voice vindicated those who argued for muscular movement; the animal spirits were distributed
control by the brain and explained what happened when through the nerves.
surgeons accidentally severed these nerves.
 In Galen’s physiological scheme, blood was continuously
 Until the sixteenth century, Galen was generally accepted as synthesized from ingested foods. The useful part of the food
the ultimate authority on anatomical and physiological was transported as chyle from the intestines via the portal
questions despite the fact that, because of Roman vein to the liver, where, by virtue of the innate faculty of the
prohibitions on human dissections, his ‘‘human anatomy’’ liver, it was transformed into dark venous blood.
was based on dissection of other species.
 Tissues could then suck up the nutriments they needed from
 Certainly, Galen did not conceal the fact that his work was the blood by virtue of their faculty for specific selection. The
based on studies of other animals, including pigs, elephants, useless part of the food was converted into black bile by the
or that ‘‘ridiculous imitation of man,’’ the Barbary ape. spleen.

 While Galen could not do systematic human anatomies, this  Like Erasistratus, Galen assumed that there must be
does not mean that he never studied human cadavers. His connections between the veins (which arose from the liver)
extensive anatomical experience made it possible for him to and the arteries (which arose from the heart) because
put fortuitous opportunities to good advantage. bleeding from any vessel could drain the whole system but
Galen ingeniously refuted the idea that, under normal
 Celsus conditions, the arteries contain only air.
- suggested that a physician could learn a good deal about
the form and functions of the internal organs by exploiting  According to Galen’s scheme, the arterial pulse was
the wounds and injuries of his patients as ‘‘windows’’ generated by the heart. During the diastole of the heart, the
into the body. dilation of the arteries drew in air through the pores in the
skin and blood from the veins. Thus, the arteries served the
function of nourishing the innate heat throughout the body.
IV. GALEN ON PHYSIOLOGY: BLOOD, BREATH, PNEUMA This concept could be demonstrated by tying a ligature
AND SPIRITS around a limb so that it was tight enough to cut off the
 Never satisfied with purely anatomical description, Galen arterial pulse. Below the ligature, the limb would become
constantly struggled to find ways of proceeding from cold and pale, because the arteries were no longer able to
structure to function, from pure anatomy to experimental supply the innate heat.
physiology.
 By extending medical research from anatomy to physiology,  For Galen’s system to work, blood had to pass from the right
Galen established the foundations of a program that would ventricle to the left ventricle. Therefore, he assumed that
transform the Hippocratic art of medicine into the science of blood in the right side of the heart could follow various
medicine. paths. Some of the blood carried impurities, or ‘‘sooty
 Given the magnitude of his self-imposed task, and the vapors’’, for discharge by the lungs via the artery-like
voluminous and prolix nature of his writings, the totality of vein (pulmonary artery). Blood could also pass from the
his work has been more honored than understood. right side to the left side of the heart by means of pores in
the septum. The pores themselves were not visible, but
 Galen’s System of Physiology (Galenic Physiology) Galen assumed that the pits found in the septum were the
mouths of the pores.
 encompassed concepts of blood formation,
respiration, the heartbeat, the arterial pulse,
digestion, nerve function, embryology, growth,  Humoralism
nutrition, and assimilation.  embodied in Galenism
 rested on the Platonic doctrine of a threefold  was capable of explaining the genesis and essence of all
division of the soul. This provided a means of dividing diseases and rationalizing all clinical findings.
vital functions into processes governed by vegetative,  According to Galen, the humors were formed when
animal, and rational ‘‘souls’’ or ‘‘spirits.’’ nutriments were altered by the innate heat that was
 Within the human body, pneuma (air), which was the produced by the slow combustion taking place in the
breath of the cosmos, was subject to modifications heart.
brought about by the innate faculties of the three - Foods of a warmer nature tend to produce bile,
principle organs: the liver, heart, and brain, which are while those of a colder nature produced an excess of
distributed by three types of vessels: veins, arteries, phlegm. An excess of bile caused ‘‘warm diseases’’
and nerves. and an excess of phlegm resulted in ‘‘cold diseases.’’
 In essence, pneuma was modified by the liver so that it - Several Galenic texts dealt with food, the humors,
became the nutritive soul or natural spirits that and the relationship between food and the humors.
supported the vegetative functions of growth and
nutrition; this nutritive soul was distributed by the veins.  After appropriate ‘‘digestion’’ in the lungs, inhaled air was
brought to the heart by the pulmonary vein. The modified air
was further acted on in the heart and transported to other

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parts of the body by the arteries. Arterial blood was skill was needed to determine how much blood should be
especially fine and vaporous so that it could nourish the vital taken, which vein should be incised, and the proper time for
spirit. Further refinement was accomplished in the arteries the operation.
that formed the rete mirabile.
 As proof that nature prevented disease by ridding the body
 Rete Mirabile of excess blood, Galen argued that many diseases that
 a network of vessels found at the base of the brain of attacked men did not affect women, because their
oxen and other animals, but not in humans. superfluous blood was eliminated by menstruation or
 The transformation of arterial blood into animal spirits in lactation. Women with normal menstrual cycles supposedly
the brain and their distribution via the nerves completed enjoyed immunity to gout, arthritis, epilepsy, melancholy,
the threefold system of spirits. apoplexy, and so forth. Men who frequently eliminated
I. GALEN ON ANATOMICAL PROCEDURES excess blood through hemorrhoids or nosebleeds could also
expect to enjoy freedom from such diseases.
V. GALEN ON THERAPEUTICS AND CAUSES OF DISEASE
 In terms of humoral doctrine, bleeding accomplished the
 When writing about the nature of therapeutics, Galen argued therapeutic goals shared by patient and physician by
that scientific knowledge of the causes of disease was apparently ridding the body of putrid, corrupt, and harmful
essential for successful treatment. materials. Some scientists suggest that bleeding might
 For prognosis, Galen relied on traditional tools, such as the actually have benefited some patients by suppressing the
examination of the pulse and the urine, and a rather rigid clinical manifestations of certain diseases, such as malaria,
version of the Hippocratic doctrine of the ‘‘critical days.’’ by lowering the availability of iron in the blood. Generally
speaking, anemia is not a desirable condition, but the
 Like Hippocrates, Galen was an excellent clinician and a availability of iron in the blood may determine the ability of
brilliant diagnostician who believed that the physician must certain pathogens to grow and multiply.
explain disease in terms of natural causes.
 ‘‘Do not inquire from the gods how to discover by  Bleeding would also affect the body’s response to disease by
divination,’’ he warned his readers, ‘‘but take your instruction lowering the viscosity of the blood and increasing its ability
from some anatomy teacher.’’ to flow through the capillary bed. Bleeding to the point of
 All diseases might have a natural cause, but Galen was fainting would force the patient along the path to rest and
willing to accept medical advice offered by Asclepius, the tranquility.
god of healing. When Galen was suffering from a painful
abscess, Asclepius appeared in a dream and told him to  Given the importance of good nursing and a supportive
open an artery in his right hand. A complete and speedy environment, it should also be noted that when a feverish,
recovery followed this treatment. delirious, and difficult patient is ‘‘depleted’’ to the point of
 Averting disease by rigid adherence to the principles of fainting, the caretakers might also enjoy a period of rest and
Galenic hygiene required continuous guidance by a recuperation.
competent physician, as set forth in Galen’s On Hygiene.
 In contrast to Celsus, who believed that the temperate  Complex drug mixtures were later called Galenicals and the
Roman had little need for medical advice, Galen argued that sign of ‘‘Galen’s Head’’ above the door identified
a highly individualized regimen was essential ‘‘for Greeks and apothecary shops. Some Galenicals were pleasant enough
those who, though born barbarians by nature, yet emulate to be used as beauty aids by wealthy Roman matrons.
the culture of the Greeks.’’
 The individualized health-promoting regimen prescribed by  Unguentum refrigerans
the physician required constant attention to the ‘‘six non-
naturals’’.  an emulsion of water in almond oil, with white wax and
rose perfume, is similar to modern cold cream.
 Six Non-Naturals
 a confusing Galenic term for factors that, unlike  Galen also developed elaborate speculative concepts about
geography, weather, season, and age, could be brought the way in which medical preparations worked and provided
under the patient’s control. rationalizations for the positive medicinal value of amulets
 Today’s health and fitness experts would refer to the and excrements. Anecdotes about the accidental discovery
non-naturals as lifestyle choices, that is, food and of the medical virtues of various noxious agents were also
drink, sleeping and waking, exercise and rest, put to good use. For example, in On Simples, Galen
‘‘regularity,’’ and ‘‘mental attitude.’’ provided a lively account of the way in which a miserable old
man suffering from a horrible skin disease was cured after
 In the hands of less gifted practitioners, Galen’s program for drinking a jug of wine in which a poisonous snake had
a sophisticated individualized approach to the prevention drowned.
and treatment of disease degenerated into a system of
bleeding, purging, cupping, blistering, starvation diets, and  Mithridates
large doses of complex mixtures of drugs.  Famous for his knowledge of medicinal herbs, poisons,
and antidotes
 Despite his reverence for Hippocrates, when confronted by  demonstrated the value of his recipes by means of
disease, Galen was not willing to stand by passively, doing human experimentation.
no harm, while waiting for nature to heal the patient. A  He was said to have sent along a condemned prisoner to
major work called Method of Healing and many other serve as a guinea pig when exchanging recipes for
texts make this preference for action abundantly clear. antidotes with other researchers
 Galen regarded bleeding as the proper treatment for almost  By taking a daily dose of his best antidotes, Mithridates
every disorder, including hemorrhage and fatigue. Great supposedly became immune to all poisons.

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 According to Galen, Nero’s physician Andromachus
used Mithradates’ poison lore to prepare the
ultimate antidote.

 Ultimate antidote
 formidable concoction containing some 64 ingredients,
including opium and viper’s flesh
 Andromachus claimed that his theriac was a health tonic
as well as a universal antidote.

 Galen’s skill and integrity were so highly regarded by his


patrons that three Roman emperors entrusted the
preparation of their theriac to him. Because others faced the
danger of encountering inferior or counterfeit products,
Galen suggested that purchasers test the strength of
theriacs by taking a drug that induced mild purging. If the
alleged theriac prevented the normal effect of the drug, it
might be genuine. Authentic theriac must be made with
ingredients of the highest quality.

 Highly respected as a physician and philosopher, Galen was


apparently as skillful in the art of medicine as in the science.
Aware of the bad repute brought to the profession by
displays of ambition, contentiousness, and greed, Galen
emphasized skill, dignity, and a disdainful attitude towards
money. He urged physicians to cultivate the art of eliciting
clues about the patient’s condition even before entering the
sickroom.
 One way was to casually question the messenger who called
for the physician, as well as the patient’s friends and family.
A secret examination of the contents of all basins removed
from the sickroom on their way to the dung heap and the
medicines already in use could provide further clues. The
pulse, casually examined while observing the patient, was
another valuable source of information. To escape blame for
failures and to win universal admiration, the physician must
cultivate the art of making his diagnoses and prognoses CHECKPOINT!
seem like acts of divination. A clever application of this tactic 1. He denounced Greek physicians as the worst
was to predict the worst possible outcome while reluctantly enemies of Rome and accused them of
agreeing to accept the case. If the patient died, the poisoning and murdering their clients.
physician’s prediction was vindicated; if the patient 2. Has many bizarre and unpleasant recipes
recovered, the physician appeared to be a miracle worker. 3. Known as the Medical Pope of Middle Ages
4. It is an essential preparation for the surgeon,
 In many ways, Galen was truly a miracle worker; his because a practitioner without anatomical
contemporaries acknowledged the remarkable quantity and knowledge could inadvertently or negligently
quality of his work. A simplified, transmuted, and partially injure his patients.
digested version of his work known as Galenism dominated 5. He suggested that a physician could learn a
medical learning throughout the Middle Ages of Europe and good deal about the form and functions of the
the Golden Age of Islam. Galen’s authority was not seriously internal organs by exploiting the wounds and
challenged until the introduction of printing and a revival injuries of his patients as ‘‘windows’’ into the
of interest in the true classics of antiquity made the body.
genuine works of Galen and Hippocrates widely available. 6. It was embodied in Galenism and was capable
of explaining the genesis and essence of all
diseases and rationalizing all clinical findings.
7. He was famous for his knowledge of medicinal
herbs, poisons, and antidotes.
8. It is an emulsion of water in almond oil, with
white wax and rose perfume, which is similar to
modern cold cream.

1. Cato the Elder


2. De materia medica (The Materials of
Medicine)
3. Galen
4. Systemic dissection
5. Celsus
6. Humoralism
7. Mithridates
8. Ungeuntum refrigerans

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